Siraneh Yibeltal, Woldie Mirkuzie, Birhanu Zewdie
Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia.
Fenot Project, Department of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia.
Int J Womens Health. 2022 Feb 11;14:179-197. doi: 10.2147/IJWH.S349053. eCollection 2022.
Positive deviance approach (PDA) was implemented as an intervention strategy to address the poor practice of exclusive breastfeeding (EBF) in Jimma town, Ethiopia. Understanding the end-users satisfaction and its drivers is essential to determine whether this approach will be viable in the long run. Therefore, we determined the level of users' satisfaction with the intervention and identified multi-level predictors to explain variability.
The data for this follow-up study were collected from September 01 to 25, 2020 among the study participants who were living in the intervention clusters of an earlier trial. A sample of 260 participants were invited to respond to an interviewer-administered structured questionnaire that assessed both individual and community-level variables. The developed tool was refined using experts' view (face validity) and using factor analysis (FA) to validate the satisfaction measurement scales (construct validity). The mean scores were standardized using Percentages Scale Mean Score (PSMS) formulae. Two-level mixed-effects linear regression (linear mixed models) were performed to fit individual, community, and mixed-level variables. All assumptions were checked for each analysis as appropriate and β-estimates at 95% CI and p-value of <0.05 were considered to declare a level of significance.
The overall level of end-users' satisfaction (PSMS) with PDA as an intervention to improve EBF was 50.9% with a maximum score of 99% and a minimum of 8%. Of the emerged satisfaction measuring scales, the standardized mean score for the user empowerment scale was the highest (53.7%). Five scales were emerged with 84.2% of the total variability explained in users' satisfaction. The mixed-effect model revealed that age, occupation, experience of breastfeeding (BF), knowledge, attitude, self-efficacy, main source of BF information, previous home visit/support received from HEPs, participation in any social activities, and perceived community support for BF were independent two-level predictors of satisfaction.
As an intermediate outcome, more than half of the end-users of the PDA intervention were satisfied. End-users' satisfaction with PDA as an intervention to promote EBF was predicted by multi-level factors. If they chose to use PDA as an intervention, Health program managers should be mindful of the two-level factors identified in this study.
积极偏差方法（PDA）被作为一种干预策略，以解决埃塞俄比亚吉马镇纯母乳喂养（EBF）的不良做法。了解最终用户的满意度及其驱动因素对于确定该方法从长远来看是否可行至关重要。因此，我们确定了用户对该干预措施的满意度水平，并确定了多层次预测因素来解释其变异性。
这项随访研究的数据于2020年9月1日至25日收集，研究对象为早期试验干预组中的参与者。邀请了260名参与者回答一份由访谈员管理的结构化问卷，该问卷评估了个体和社区层面的变量。使用专家意见（表面效度）和因子分析（FA）对开发的工具进行完善，以验证满意度测量量表（结构效度）。使用百分比量表平均分（PSMS）公式对平均分进行标准化。进行了二级混合效应线性回归（线性混合模型）以拟合个体、社区和混合层面的变量。对每个分析都酌情检查了所有假设，95%置信区间的β估计值和p值小于（0.05）被视为具有显著水平。
作为改善纯母乳喂养的干预措施，最终用户对积极偏差方法的总体满意度（PSMS）为50.9%，最高分为99%，最低分为8%。在出现的满意度测量量表中，用户赋权量表的标准化平均分最高（53.7%）。出现了五个量表，解释了用户满意度中84.2%的总变异性。混合效应模型显示，年龄、职业、母乳喂养经验（BF）、知识、态度、自我效能、母乳喂养信息的主要来源、之前从健康推广人员处接受的家访/支持、参与任何社会活动以及感知到的社区对母乳喂养的支持是满意度的独立二级预测因素。
作为一个中间结果，超过一半的积极偏差方法干预的最终用户表示满意。最终用户对积极偏差方法作为促进纯母乳喂养的干预措施的满意度由多层次因素预测。如果健康项目管理者选择使用积极偏差方法作为干预措施，应该留意本研究中确定的二级因素。
